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14 Dec 2006 : Column 354WH—continued
Andy Burnham:
I understand the hon. Gentleman’s point. He is saying that we should allocate funds
according to actual levels of disease in constituencies, whether cancer, coronary heart disease or stroke. However, the levels of disease are higher in my constituency than they are in his.
Mr. Lansley: Perhaps higher than in mine but not higher than in the constituency of my hon. Friend the Member for Eastbourne.
Andy Burnham: The levels are higher, and I shall write to the hon. Gentleman on that. They are higher than the levels in every constituency represented on the Opposition Benches. Manchester has the lowest life expectancy in the country. [Interruption.] I do not misunderstand the issue at all; in fact, I know it extremely well. The burden of disease is higher in areas with the lowest life expectancy than it is in areas with the longest life expectancy. Our formula creates a balance. It does not take just one thing and say that that will be the key determinant by which resources are allocated. It balances deprivation and need against factors such as age.
Mike Penning: It does not balance; it skews.
Andy Burnham: It is a balanced formula that tries to allocate resources fairly across the country, and that is what it does.
Gregory Barker: Is not the proof of the pudding in the eating? If, as the Minister says, it is a balanced formula, why are the Opposition Benches swollen with Members from the south of England whose local health authorities are in financial crisis, yet not a single Labour Member with a constituency in the midlands, the north or anywhere else is here to stand up and complain? Is there not a fundamental financial imbalance between north and south and, de facto, a formula that does not work fairly?
Andy Burnham: The short answer is no. I gave two examples of reconfigurations—in Greater Manchester and in Calderdale and Huddersfield—that are in Labour areas.
I shall give the hon. Gentleman an honest answer to his question about why there are differences between one health economy and another: it is because the NHS is not the same everywhere. The money funds different infrastructure in different parts of the country. For whatever reason—the reasons are complicated—there are more GPs per 100,000 population in the constituencies of almost every Opposition Member in the Chamber. Pre-NHS, those communities probably could have afforded to build health infrastructure that areas like mine could not afford, so there is greater provision of community hospitals and smaller hospitals there. In some parts of the country, there are acute services and, as I was saying to the hon. Member for Hemel Hempstead, a district general hospital for a smaller population.
The NHS establishment is different in different parts of the country. Constituencies such as mine have fewer GPs, no community hospitals and a large acute trust. The infrastructure is different. Some argue that it is
more efficient. I will not be the judge of that, but it is different. That is why some of the issues to do with change in health services are extremely important. I hope that I have answered the question of the hon. Member for Bexhill and Battle.
Tim Loughton: What the Minister is saying is right, of course. Health services are different in different parts of the country because health needs are different. However, on the subject of GPs, if he were to go to Worthing, Eastbourne or Bognor Regis and speak to any of the GPs there, they would tell him that an 85-year-old requires, on average, twice as much attention from a GP as a 75-year-old. We are talking about extra old weighting. If the Minister is now saying that we will lose GPs, we will have serious problems because of the requirements of our elderly population.
Andy Burnham: I am not saying that. That demonstrates the dishonesty of the hon. Gentleman’s position. I do not accept the argument—this is the nub of the debate—that an 85-year-old needs more attention from a GP because she is 85. We know that cancer patients, stroke patients and coronary heart disease patients will need help from a GP and access to their time. The fact that somebody is old does not necessarily mean that they will be a high consumer of health services. I remind him that his party allocated resources based on the burden of disease, not on age. Which one is it?
Andy Burnham: The hon. Gentleman clearly does not like the explanation, but it happens to be true. My point is that there are more GPs in his constituency than in mine, and there is an intermediate tier of facilities and secondary services. That is why some of these debates are occurring. If he wants to intervene and contradict that, he is welcome to do so. [Interruption.] I have been generous with interventions and have taken every one that has been asked for, so hon. Members cannot complain that there is not enough time for their contributions.
We are working towards an 18-week target by the end of 2008. That will lead to further change of NHS services. It will mean more vertical integration of services with more services where GPs and consultants work more closely together. That will benefit the patient because it will offer quicker care. It will put services in the right setting and the right location. Conveniently for them, it will allow consultants time to spend with the cases that they really need to see.
This is an ambitious programme of change for the national health service as it approaches its 60th year. We are making changes because medicine is changing. As I said, the priority should be saving lives and improving the quality of care to our constituents. It is in that challenge that politicians need to show leadership. They need to speak up for change where the clinical community says that it is in the best interests of the local population. That challenge falls to every hon. Member, and if we can grasp that challenge I am confident that we will build a national health service that is better able to meet the needs of the British public well past its 60th year, into many further decades.
Mr. Eric Illsley (in the Chair): Order. It goes without saying, but time is now somewhat limited. Can I appeal to hon. Members for a reasonably crisp and brief contribution so that I can try to accommodate everybody?
3.41 pm
Peter Bottomley (Worthing, West) (Con): Earlier this afternoon, the Minister introduced a debate on medical and clinical practice. Last weekend at six o’clock on Saturday, at Worthing hospital, the mayor of Worthing together with patients and others—with Labour people, Liberal Democrats, Conservatives and people without party all taking part—started a 24-hour vigil. During those 24 hours, 10 new mothers had their babies delivered safely, three by section. It is not obvious to anybody in Worthing why mothers should either have to have their babies at home or travel for40 minutes to an hour down the road to go to another hospital. Accident and emergency saw and treated147 patients, 24 of whom were admitted. I think that the Minister would accept that if they were admitted, they needed to be in hospital. Such cases cannot be treated at home; they should not be expected to go for 40 minutes to an hour down the road to another hospital. Four people had moderate or severe injuries as the result of accidents and the hospital’s trauma team was in attendance awaiting the arrival of the ambulance.
In the week before the vigil, the Prime Minister put his name to the estimate that if people could be taken straight to the relevant hospital, 500 lives a year could be saved. That would be a worthwhile total. Such a hospital could give angioplasty straight away—Worthing hospital can do so. It would be good if the Prime Minister were not quoted by other parts of the health service as saying that his words will save lives when the consultants at Worthing say that they could provide the angioplasty themselves and that if people from A and E at Worthing had to go down the A27 to Brighton, to Chichester or to Portsmouth lives would be lost. Clearly, such issues are a matter of balance.
I am trying to illustrate what is behind the courteous disagreement between the chief executive of the strategic health authority and me. In the middle of the year, she said that I was being alarmist and sensationalist—she also included my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—about the future of our hospital. I rang up and asked whether, when the proposals came out, she was sure that they would not include proposals to close the A and E or to downgrade Worthing and Southlands hospitals. She said no. I asked whether she was sure that there would not be a proposal to close the hospital altogether. She said no.
It is not an MP’s job to keep quiet when information that six out of the nine options that are being considered include the closure of the A and E unit or the closure of the hospital is disclosed under freedom of information provisions rather than in a straightforward notification to MPs. I hope that there will be an instruction throughout the health service that, if options are being considered that include the closure of A and E in a busy hospital, MPs should be
informed without having to apply under freedom of information provisions. I do not see why any director of a strategic health authority or primary care trust should have information of that nature without the MP being informed.
I return to what happened during the 24-hour vigil. The intensive therapy unit was running at full capacity, treating critically ill patients. The high dependency unit was full to capacity. There were 500 beds available throughout the Worthing and Southlands hospital trust, and fewer than 13 were unoccupied. That does not strike me as being a reason to downgrade a hospital or to close it.
Tim Loughton: And it was a quiet night.
Peter Bottomley: My hon. Friend adds the useful information that it was a quiet night. In total,35 patients were admitted. That is estimated to be more than are admitted to many of the big London teaching hospitals, and I do not think that anyone is going around suggesting that one of those should be closed.
Two heart attack patients were treated in the coronary care unit. There were three cardiac arrests. The hospital team assessed, resuscitated and stabilised one critically ill patient and provided medical management for the ambulance transfer to the regional specialist unit. Co-operation across the region for Worthing and other hospitals happens as it does in other parts of the country. That has not changed in terms of medical and clinical practice, and it is not likely to change.
In the 24-hour period, four patients had their broken hips replaced or repaired. That could not happen at home and need not happen 40 minutes to an hour down the road at Brighton, Chichester or Portsmouth. Radiographers took 144 X-rays. We might at some stage have portable X-ray equipment, but at the moment it is probably better that X-rays take place in hospitals, so that will not be transferred to the community, although I recognise that GPs are capable of doing more.
The Minister rightly referred to developments in audiology. I want to add that he could have said that audiology is excluded from the “Let’s have no more than 18-week waiting times in two years’ time” target. In Worthing, and I suspect in many other places, the waiting time for a 20-minute hearing test is more than two years. Someone aged 89 whose hearing might have deteriorated and who plays their radio or television—often their only companion—at a level that disturbs their neighbours who live above, below or either side of them if they live in a semi-detached property, has to wait more than two years for a 20 minute procedure and then face an emergency block on capital spending ordered by the strategic health authority so the £71 for the hearing aid is not allowed. My hon. Friend the Member for East Worthing and Shoreham and I managed to get that decision reviewed and overturned.
Many people live on the south coast. When we first became MPs for our constituencies, 44 per cent. of the population was over 65 and the figure for those over 85 was pretty equivalent to those for the constituency of my hon. Friend the Member for Eastbourne.
Tim Loughton: The A and E department at Worthing is particularly crucial and my hon. Friend will know that over recent weeks the Royal Sussex county hospital in Brighton, to which it is possibly proposed to transfer the A and E admissions from Worthing—some 63,000 last year—was on divert for its ambulances to go to Worthing A and E department. The hospital in Brighton could not cope with the level of work that it already had, let alone take on what it might have to in the future, which would be a large proportion of that 63,000 if these crazy proposals go ahead.
Peter Bottomley: May I put on record a point of detail in the expectation that the primary care trust, the strategic health authority, the national headquarters of the NHS and the Department of Health will pay attention to the debate? If we have 3,500 staff in our hospital trust and if more than 1,000 patients a day are treated and many of those patients have family or friends who bring them in or come to visit and use the car park, diverting those patients to a hospital with no easy access either by public or private transport would make life worse rather than better.
I return to what happened in the 24 hours from 6 pm on Saturday to 6 pm on Sunday. There were 144 X-rays, and four patients had CT scans in the new scanner. There were hundreds of blood tests: 115 patients had haematology tests and 119 had biochemistry tests. The blood groups of 60 patients were determined, 30 units of blood were cross-matched for administration and two patients required haemodialysis and ITU to treat acute renal failure. During the day, before the vigil started, 20 patients had regular dialysis for chronic renal failure.
On that day 22,000 litres of oxygen were given; 3,000 litres of nitrous oxide were given; 345 litres of intravenous fluids were given and administered through 500 metres of intravenous tubing; and more than 1,000 syringes were used. I doubt whether all that treatment could easily be transferred into the community; and I do not see why it should have to be transferred, along with the staff, 3,500 patients and their families and friends, who would have to go by minibus from Worthing to a hospital in Brighton or Portsmouth along the A27, especially as the road is often blocked. It seems to me that if the staff, the patients, and the family and friends are in one town—the biggest town in West Sussex—the patients probably ought to be treated in the hospital where they are treated at the moment. Ministers have rightly taken credit for continuing investment in that hospital; it started before 1997, but I assume that we can be non-party political about it and share the credit.
I move on. That 24-hour period saw the administration of £20,000 worth of drugs, with pharmacy staff dispensing more than 200 prescriptions. That weekend, a total of 28 patients had surgery. The operations lasted from30 minutes to 10 hours. Such operations could not have taken place in a GP’s surgery or a one-stop clinic. On Saturday afternoon, while others may have been watching football, four operating theatres were running simultaneously. It was a quiet weekend; 1,000 patients are normally seen and treated every weekday.
None of that is a criticism of the Minister; it is a description of what we take for granted from the support staff, the nurses, the doctors and the managers
in our health service, and I do not exclude the family doctor service and clinics, as many patients were referred by their GPs. There is much co-operation.
I hope that those figures help to illustrate the debate, but it is wrong to say that we could do without one or even two acute hospitals in West Sussex. We do not want two towns to get into a fight; we believe that we have an established service that can be adapted and that can evolve, but we do not want people trying, in effect, to wreck one of our centres of excellence.
I hope that we can spend some time talking about funding. I illustrate the point to the Minister, but I do not wish to get into an argument; we should resist that temptation. In my constituency, people live at the same address for an average of 14 years. That is twice the national average. Many people come to the area in their maturity. Someone who retires to the constituency at the age of 65, perhaps from an inner-city area, may live there for 14 years, but it is during the last eight years—often the last four years and frequently the last 18 months—that they make most demands on the health service. Those demands would be roughly the same if they had been less fortunate and been ill at the age of 55. However, if people do not spend their healthy years in our constituencies, but spend only their mature years there—the times when they are ill—the funding formula clearly cannot continue as it is. I shall not elaborate on that. The Minister is clever enough to understand the point.
We are also suffering dramatically from the penalty formulas for hospitals in deficit, and that has had an impact on our medical and clinical practices. The Government now understand not only that the penalty system introduced in 2000-01 is inappropriate but that it must end. If our hospital has apparently overspent by £10 million, it will have to save that money the following year. That is a £20 million hit, and it is wrong. I hope that the Minister accepts that that needs to change. Hospitals are being told first that they will lose 3 per cent. for one reason or another, secondly that they will lose their penalty money and thirdly that they will have to repay it. In addition, they are under instruction from the strategic health authority that no consultant with a space in their clinic is allowed to see a patient referred in the past eight weeks by a GP. Such interference from the centre is totally unjustifiable—unless the Minister wants to justify it.
Finally, funding problems affect doctors in training—people who are cheerfully called junior doctors even though they may be 37 years old and just about to take a consultant’s role. The SHA, I think on instruction centrally from the NHS, has been told that junior doctors in training will have none of their training costs reimbursed for the rest of the year. That is an in-year imposition. If that is untrue, I hope that the Minister will say so. If he does not contradict me, we must assume that I am correct. However, although the information may be correct, it is the wrong thing to have done.
Health Ministers have a difficult job, especially as during this last year the chief executive of the health service has changed twice, every strategic health authority in England seems to have changed and primary care trusts and personnel have changed. Many hospital trusts also have new chief executives or chairmen. It is a miracle that we still have as much medical service as we have.
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